Outer Ear Flashcards
What is the ear split up into
External
Middle - from TM to oval window
Inner
What is the pinna / auricle and what epithelium and structures make up
External structure of ear
Stratified keratinised epithelium
Elastic cartilage underneath
What does it continue as
Concha continues as external auditory measures
Is it good at sound localisation
No so minimal loss if obstruction
Function is to capture and transmit sound to EAM
What supplies the pinna
Mandibular branch of trigeminal (V3)
What supples the external auditory meatus
Anterior = facial
Posterior =vagus
What is lateral 1/3 made up of
Skin and cartilage
Sebaceous glands to produce wax
Thick hair
Protective barrier
What is medial 1/3 made up of
Skin and bone
No hairs or cilia
Doesn’t produce wax
How does skin grow in the external ear canal
Umbo of the tympanic membrane outwards
Shed in lateral 1/3 and trapped in wax
Why you shouldn’t remove wax
What are outer eat problems
Auricle haematoma
Foreign boy
Otitis externa
Mastoiditis
How do you Rx haematoma
Drain
How does foreign body present
Foul discharge Pain Hearing loss Unilateral Requires removal Gental syringing may help
What is otitis externa
Inflammation of external ear canal
Usually unilateral
Can be acute or chronic
What is most common causes
Bacteria = most common - - S.aureus / S.epidermis - Pseudomonas with hearing aid Can get fungal - Increased risk after prolonged Ax Seborrheic dermatitis Contact dermatitis
What are the symptoms
Ear pain - acute on moving pinna
Itch
Discharge
Temporary conductive hearing loss
What is seen O/E
Red or white swollen EAM
May not be able to see TM due to swelling
May have lots of pus / purulent discharge
Try see TM to look for perforation which can cause 2 otitis external
What are RF
Swimming Eczema - seborrheic / contact Absence of wax from self cleaning Asthma Allergic rhintiis Foreign body Immunosuppression e.g.DM
What should you ask about / examine
Fever Tinnitus Discharge Examine nose + throat Look behind ear for swelling / scar Lymph nodes
What can’t you rule out
Otitis media / perforation as can’t see tympanic membrane
What is treatment
Antibiotic ear drops + steroid = 1st line
- Gentamicin - CI if perforated TM so if can’t see don’t give
- Ciprofloxacin (unlicensed)
- Neomycin
- Have brand names
Steroid ear drop to reduce inflammation
Anti-fungal
Can give capsule if severe - fluxloaxcillnin = 1st line for oral
IV if malignant
Syringe out debris so more effective
Refer ENT if fail to respond to topical Ax
Avoid water
What is chronic otitis externa
Chronic infection in EAM
Usually staph or fungal
What are the symptoms
Chronic discharge
Hearing loss
Severe pain
How do you Rx
Cleansing of external ear
Anti-fungal and Ax ear drops
What is malignant otitis externa
Caused by spread of otitis externa into bony ear canal
What causes
S.Aureus
Pseudomona’s
What are RF
Immunosuppressed
Chemotherapy
Elderly
DM in 90% of cases
What are the symptoms
Failure to response to Ax OM temporal bone Persistent and foul smelling discharge Pain out of proportion Ear pain Temporal headache Purulent otorrhoea Hearing loss Fever Dysphagia Hoarseness Facial nerve dysfunction
How do you Dx
Refer any non resolving otitis external with worsening pain to ENT
CT scan
Can do swab for sensitivity
How do you Rx
Surgical debridement
IV Ax to address OM and cover pseudomona’s
Ciprofloxacin
Gent - not used if TM perforated as ototoxic
What is CI if malignant
Syringing ear
What can referred ear pain be from
Mostly from teeth
What can a pinna haematoma cause
Cartilage of ear starved of blood supply
Leads to cauliflower ear
When do you give Ax
Red oedematous narrow canal Conductive hearing loss Discharge Regional LN Cellulitis behind ear Fever
How do you manage excessive wax
Topical ear drop - olive oil
Microsution
Syringe
Suction in ENT clinic
What do you do for recurrent otitis media
Can insert inflation tube
